N,34, had been grappling with fertility issues for the past 2 years. Her reproductive system was normal with no obvious pelvic masses such as fibroids or ovarian cysts. Her menstrual cycles were regular, occurring every 28 to 30 days. There was no menstrual discomfort or pain and her vaginal discharge was normal without any foul odor. N could identify transparent, clear egg-white vaginal discharge during ovulation quite accurately. She had regular sexual intercourse during this period. Her husband, however, refused to be checked initially as he thought there was nothing wrong with him. With much persuasion, he finally turned up for a consultation albeit reluctantly.
N’s husband, 37, was a relationship manager in a bank. He was under a lot of “work stress” for the past years and went for sauna baths regularly with friends for relaxation. There was no significant medical, surgical or family history of note. He was overweight with a BMI of 28 as he ate most of his meals outside. He smoked more than 20 cigarettes a day and drank 3-4 cans of beer every weekend with friends to “de-stress”. Semen analysis revealed that his sperm count was on the low normal range and the quality of the sperm was slightly below par.
Why Male fertility checks?
About one in 5 to 6 couples in Singapore has fertility issues and about 50% are due to male disorders. Male fertility checks may help identify the underlying problems. These problems affect not only conception but may also pose risks to the mother and the baby during pregnancy.
What are the Male Fertility Checks?
Clinical assessment:
This includes medical history taking and physical examination. A review of medical history, including past illnesses, surgeries, medications, and family history of genetic disorders or fertility problems, can provide valuable insights into potential risk factors.
A comprehensive physical examination can assess overall health and identify any underlying medical conditions that may affect fertility or pregnancy. Examination of the reproductive organs may detect abnormalities such as varicoceles (enlarged veins in the scrotum) or other structural issues.
Lifestyle Assessment:
Lifestyle factors such as smoking, alcohol consumption, recreational drug use (e.g. Marijuana), diet, exercise habits and exposure to environmental toxins can impact fertility as they can contribute to oxidative stress, inflammation, hormonal imbalances and DNA damage in sperm cells.
Prolonged exposure to heat, such as sauna or wearing tight underwear, may also negatively impact sperm quality. A thorough assessment of lifestyle habits can identify areas for improvement to optimize reproductive health.
Chronic stress can disrupt hormonal balance and negatively affect fertility. Practicing stress-reduction techniques such as mindfulness, meditation, yoga, or counseling can help alleviate stress and improve reproductive health.
Semen Analysis:
Semen analysis is important to assess sperm quantity and quality. It evaluates various parameters such as sperm count, morphology (shape), and motility (movement). Abnormalities in any of these parameters can indicate potential fertility issues.
Hormone Testing:
Hormones play a critical role in sperm production and reproductive function. Imbalances in hormone levels can affect sperm production and its quality.
Tests include measuring levels of testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin.
STD Testing:
Sexually transmitted infections (STDs) can impact fertility and pose risks to pregnancy and the unborn baby. Tests for common STDs such as chlamydia, gonorrhea, syphilis, and HIV are usually recommended.
Prompt treatment of STDs can prevent complications and protect reproductive health.
Genetic Screening:
Genetic testing can identify inherited conditions or chromosomal abnormalities that may affect fertility or increase the risk of passing genetic disorders to the offspring.
Tests may include screening for conditions such as chromosomal abnormalities (e.g., Klinefelter syndrome), and genetic mutations linked to infertility.
Counseling and Education:
N was counselled on various aspects of sperm care and educated on how to modify his lifestyle habits. He was given supplements and antioxidants including vitamin C, vitamin E, selenium, and coenzyme Q10. These micronutrients help reduce oxidative stress and improve sperm quality. He subsequently changed to a less stressful job in the financial industry and six months after he stopped smoking, his sperm parameters improved to normal levels. The couple was overjoyed when they saw the baby’s heart beating regularly at 6 weeks gestation at the last review a few weeks ago.